Starting treatment for multiple myeloma: What you need to know
Any cancer diagnosis comes with questions, fears, and uncertainty, and a rare cancer like multiple myeloma tends to turn up the dial on all of them. Treatment for multiple myeloma depends on factors like the stage of disease progression you’re at, what your symptoms are like, and your health in general. Here’s what you need to know as you consider your treatment options.
Stages of multiple myeloma
One of the most significant factors in your treatment options is the stage at which you’re diagnosed. If you’re asymptomatic, you likely will require only monitoring until your healthcare provider finds signs that the disease has progressed. Those signs are referred to as CRAB criteria:
calcium elevation
renal dysfunction
anemia
bone pain or lesions
Myeloma also may cause symptoms related to the blood, like nosebleeds or unusually heavy menstrual periods, or hyperviscosity, meaning thickened blood. Headaches, dizziness, and blurred vision are signs of hyperviscosity.
Other markers that treatment is necessary occur in the bones:
60% or more plasma cells in the bone marrow
the ratio of abnormal to normal proteins in bone marrow plasma
at least one 5 mm or greater bone lesion
An overview of multiple myeloma treatments
The course of action you and your treatment team choose depends in large part on your overall health and disease stage, but it also has a lot to do with your personal preferences. Be sure to ask a lot of questions and speak up about what does and does not feel right to you.
Multiple myeloma treatments fall into five main categories:
Recently developed non-chemotherapy drugs
These are often used in combination with a steroid, standard chemotherapy, or each other.
Immunomodulatory drugs give your immune system a boost, making it better equipped to fight the cancer cells.
Proteasome inhibitors block the action of proteasome, which is in overdrive within myeloma cells and breaks down cell proteins. These drugs cause proteins to build up in myeloma cells, which kills them.
Nuclear export inhibitors block the mechanism in a cell that moves proteins out of the cell nucleus. As with proteasome inhibitors, proteins build up in the myeloma cells, and they die as a result.
Monoclonal antibodies attack antigens on the surface of myeloma cells, which then signal immune cells to come attack.
Chemotherapy
Chemotherapy remains the standard of care for so many cancers, uses powerful chemicals to kill fast-growing cells in your body. Multiple myeloma patients find a range of results from chemotherapy, from partial control of disease progression to full remission. It does present risk of serious side effects, many of which can be addressed with companion medicines.
Corticosteroids
Corticosteroids often are used to support chemotherapy by reducing associated nausea and vomiting.
CAR-T therapy
This form of therapy accelerates your immune system by removing T cells and other white bloods cells from your blood, treating them to recognize a marker on myeloma cells, and then re-introducing them to your body, where they then kill cancer cells.
Bone marrow transplantation
This is an effective treatment, but one that not every patient is right for. This treatment is rarely an option for patients who are 65 or older.
Working with your care team
Because multiple myeloma is rare, many general practitioners have little to no experience treating it. Even the specialists in your area may treat only a handful of multiple myeloma patients each year. The range of characteristics of the disease and its progression through various areas of the body make it especially complicated to treat. Often, the age of patients—most are in their 60s or older—adds additional complications.
All of that means you’ll want to choose your medical team with care. Your general practitioner may have recommendations for a hematologist-oncologist, or specialist in cancers of the blood. But don’t stop there. In addition to making sure a provider is covered by your insurance, you’ll want to ask questions about treatment philosophy and level of experience. Some specific questions follow:
What can you tell me about my risk of disease progression and relapse?
What are the risks and benefits of the treatment options you recommend?
How will my treatment choices affect my treatment options going forward?
How can I best prepare for treatment?
What can I expect from treatment, in terms of side effects and impact on my daily life?
How will you monitor my progress, and what signs will tell us we need to reconsider treatment?
What new trials might be appropriate for me?
Newer treatment trials are an important option for rare diseases like multiple myeloma and represent an important, active area of research. You can find them for any stage of the disease and, if you’re an appropriate volunteer, you’ll be among the first to try new methods of treatment that may be more effective than other available treatments. The downside is that you might also encounter unexpected side effects or not get the results you were hoping for.
Addressing emotional and other effects of multiple myeloma
Treatment options have improved over the past several years, and patients are seeing increased life expectancy, but the reality is that multiple myeloma can seriously impact your quality of life. Addressing lifestyle issues can also reduce the disease burden:
Physical activity is usually safe during and after cancer treatment, and research shows that 30 minutes of aerobic activity three times per week, daily stretching, and at least two days of resistance training reduces fatigue, improves strength and fitness, and combats anxiety. Multiple myeloma often makes physical activity more challenging than other cancers, so work with your care team to find your best options for movement.
A diet that includes a lot of plants — 2-3 cups of vegetables and 1 1/2 to 2 cups of fruit per day — includes more whole than refined grains, and is low in processed meats and red meat is recommended by the American Cancer Society. Research into multiple myeloma and diet specifically is lacking, but there is good reason to assume that the recommended diet will help support overall health and recovery.
Although many cancer patients note changes in their ability to sleep during treatment, there is strong evidence linking sleep to quality of life. Doing what you can to set a routine, make time for sleep, avoid screens before bed and other sleep hygiene practices is worth the effort.
Avoiding substance use is especially important while treating multiple myeloma. Alcohol and cigarettes are known carcinogens, and they bring a cascade of negative health effects that can inhibit not just well-being but treatment efficacy.
As you proceed through treatment, remember also that connecting with others and finding emotional support is important. Visit our Inspire Myeloma Support Community to read about others’ experiences and share your own story.
Sources
https://www.cancer.net/cancer-types/multiple-myeloma/stages
https://www.nhs.uk/conditions/multiple-myeloma/symptoms/
https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics
https://themmrf.org/diagnosis-and-treatment/building-the-right-treatment-team/
https://www.cancer.net/cancer-types/multiple-myeloma/about-clinical-trials
https://www.nature.com/articles/s41408-021-00560-x
https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html
https://www.myeloma.org/support-groups
Disclaimer
Member comments have been lightly edited for length and clarity. This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.
